Healthcare Provider Details

I. General information

NPI: 1417316415
Provider Name (Legal Business Name): CHH MERRITTS CREEK FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEADOW POINTE
BARBOURSVILLE WV
25504-9209
US

IV. Provider business mailing address

100 MEADOW POINTE
BARBOURSVILLE WV
25504-9209
US

V. Phone/Fax

Practice location:
  • Phone: 304-399-6833
  • Fax: 304-399-2987
Mailing address:
  • Phone: 304-399-6833
  • Fax: 304-399-2987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberWV 19564
License Number StateWV

VIII. Authorized Official

Name: MISS MARIA JOY WORKMAN
Title or Position: REFERRAL CLERK/RECEPTIONIST
Credential:
Phone: 304-399-6833